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Organization · Preferred Provider Organization · Shreveport,, LA

NPI
1619175551
Type
Organization (Type 2)
Primary specialty
Preferred Provider Organization
Specialty group
Managed Care Organizations
Taxonomy code
305R00000X
License number
PCA9546 (LA)
Enumerated
2007-07-03
Last updated
2020-08-22
Practice location
9300 Manfeid Road, Suite 204
Shreveport,, LA 71118
(318) 671-8131

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